Müllerian tract anomalies and urinary tract infections

Müllerian tract anomalies and urinary tract infections Sir,There is a proven association between urinary tract infections (UTI) and preterm birth. There is a recognized link between genital and urinary anomalies ; 30–50% of Müllerian duct anomalies are associated with urinary tract defects . Given this association, we determined if some women with uterine anomalies should be monitored more closely for UTI.We hypothesized that women with uterine anomalies were more likely to have a UTI during pregnancy. We studied women attending an inner‐city prematurity surveillance clinic between 2011 and 2017. Data were collected using the Preterm Clinical Network Database (REC ref. 16/ES/0093 on 15/9/2016). Rates of UTI (confirmed with growth on urine culture) in women with uterine anomalies were compared with a control group of those at high‐risk of preterm birth but without uterine anomalies.In all, 82 women with uterine anomalies were analyzed, and 82 high‐risk controls, consecutively collected. Anomalies included septate (15%), subseptate (1%), didephys (11%), unicornuate (10%), bicornuate (54%), t‐shaped (1%) and arcuate (9%) uteruses. There were low numbers and equal rates of UTI in women with uterine anomalies and those without (4.9% vs. 4.9%, p = 1). Rates of preterm birth at <28 weeks (2.4% vs. 2.4%) and <32 weeks (3.7% vs. 2.4%, p = 0.650) were similar, but there was a possible trend towards deliveries before 37 weeks of gestation (22% vs. 11%, p = 0.058). Women with uterine anomalies had significantly fewer vaginal deliveries (34.2% vs. 59.0%, p = 0.003) and more elective cesareans (29.3% vs. 14.8%, p = 0.042).In our cohort of high‐risk women, uterine anomalies were not a risk factor for UTI during pregnancy. They can be managed as other high‐risk women and do not require extra screening for UTI compared with other high‐risk women. They have similar rates of early preterm birth compared with others in the high‐risk clinic and so require management in a Prematurity Surveillance Clinic. They were significantly more likely to have a cesarean section rather than vaginal delivery – likely due to obstetric risk factors, agreeing with other studies .There were very low rates of UTI in women with uterine anomalies, suggesting that this does not increase the risk of UTIs due to associated renal tract abnormalities. Additional risks in this group are not associated with UTIs. Women with uterine anomalies do not require extra screening for UTI. However, they remain at high risk for preterm birth and should be under the care of a Preterm Surveillance Clinic.ReferencesFedele L, Bianchi S, Agnoli B, Tozzi L, Vignali M. Urinary tract anomalies associated with unicornuate uterus. J Urol. 1996;155:847–8.Wang S, Lang JH, Zhou HM. Symptomatic urinary problems in female genital tract anomalies. Int Urogynecol J. 2009;20:401–6.Hua M, Odibo AO, Longman RE, Macones GA, Roehl KA, Cahill AG. Congenital uterine anomalies and adverse pregnancy outcomes. Am J Obstet Gynecol. 2011;205:558.e1–5. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Acta Obstetricia Et Gynecologica Scandinavica Wiley

Müllerian tract anomalies and urinary tract infections

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Publisher
Wiley
Copyright
Copyright © 2018 Acta Obstetricia et Gynecologica Scandinavica
ISSN
0001-6349
eISSN
1600-0412
D.O.I.
10.1111/aogs.13285
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Abstract

Sir,There is a proven association between urinary tract infections (UTI) and preterm birth. There is a recognized link between genital and urinary anomalies ; 30–50% of Müllerian duct anomalies are associated with urinary tract defects . Given this association, we determined if some women with uterine anomalies should be monitored more closely for UTI.We hypothesized that women with uterine anomalies were more likely to have a UTI during pregnancy. We studied women attending an inner‐city prematurity surveillance clinic between 2011 and 2017. Data were collected using the Preterm Clinical Network Database (REC ref. 16/ES/0093 on 15/9/2016). Rates of UTI (confirmed with growth on urine culture) in women with uterine anomalies were compared with a control group of those at high‐risk of preterm birth but without uterine anomalies.In all, 82 women with uterine anomalies were analyzed, and 82 high‐risk controls, consecutively collected. Anomalies included septate (15%), subseptate (1%), didephys (11%), unicornuate (10%), bicornuate (54%), t‐shaped (1%) and arcuate (9%) uteruses. There were low numbers and equal rates of UTI in women with uterine anomalies and those without (4.9% vs. 4.9%, p = 1). Rates of preterm birth at <28 weeks (2.4% vs. 2.4%) and <32 weeks (3.7% vs. 2.4%, p = 0.650) were similar, but there was a possible trend towards deliveries before 37 weeks of gestation (22% vs. 11%, p = 0.058). Women with uterine anomalies had significantly fewer vaginal deliveries (34.2% vs. 59.0%, p = 0.003) and more elective cesareans (29.3% vs. 14.8%, p = 0.042).In our cohort of high‐risk women, uterine anomalies were not a risk factor for UTI during pregnancy. They can be managed as other high‐risk women and do not require extra screening for UTI compared with other high‐risk women. They have similar rates of early preterm birth compared with others in the high‐risk clinic and so require management in a Prematurity Surveillance Clinic. They were significantly more likely to have a cesarean section rather than vaginal delivery – likely due to obstetric risk factors, agreeing with other studies .There were very low rates of UTI in women with uterine anomalies, suggesting that this does not increase the risk of UTIs due to associated renal tract abnormalities. Additional risks in this group are not associated with UTIs. Women with uterine anomalies do not require extra screening for UTI. However, they remain at high risk for preterm birth and should be under the care of a Preterm Surveillance Clinic.ReferencesFedele L, Bianchi S, Agnoli B, Tozzi L, Vignali M. Urinary tract anomalies associated with unicornuate uterus. J Urol. 1996;155:847–8.Wang S, Lang JH, Zhou HM. Symptomatic urinary problems in female genital tract anomalies. Int Urogynecol J. 2009;20:401–6.Hua M, Odibo AO, Longman RE, Macones GA, Roehl KA, Cahill AG. Congenital uterine anomalies and adverse pregnancy outcomes. Am J Obstet Gynecol. 2011;205:558.e1–5.

Journal

Acta Obstetricia Et Gynecologica ScandinavicaWiley

Published: Jan 1, 2018

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